Understanding the Social Stratification and Diffusion of Health-Related Innovations Using the 20th Century Pattern of Converging, Diverging and Stable Racial Disparities in Mortality in the U.S.

Margaret M. Weden, RAND Corporation

Historical patterns of racial disparities in mortality provide insight about the stratification of social, economic, cultural and technological resources in the U.S. These historical patterns provide a marker of the pace and diffusion of longevity-promoting innovations through different populations, and they entail four possible patterns: divergence, convergence, stability or dynamic progression. I relate these patterns to theory about the pace and stratification of survival and test them using data on relative differences in mortality by race over the 20th century. I consider trends in cause-of-death-relevant age groups that describe disparities in mortality that have occurred through the epidemiological transition in the principal cause of mortality from infectious disease to chronic conditions and a potential recent transition to greater senescent mortality. Preliminary findings support a dynamic progression of disparities in mortality. I relate these findings to a refinement of the “fundamental cause” approach to social disparities in population health.